In case after case of violence and homicides at Canadian long-term care facilities W5’s research kept pointing to patients with dementia attacking other patients. And all indications are that the problem is only going to get worse.
According to the Alzheimer’s Society of Canada this country is on the edge of a crisis -- the number of Canadians with dementia will increase from 747,000 today to 1.4 million in 2031. And the costs are rising. Additional information from the Alzheimer’s Society can be found in an article they provided to W5: "People first in dementia care".
Having reported about violence in our series about long-term care facilities, W5’s team wanted to show more than problems. We wanted to find solutions.
We began by conducting extensive research on best practices in long term care around the world. While we learned some European countries were adopting innovative small-scale living models to deal with the complex care needs of nursing home residents, we were particularly intrigued by a Canadian home trying to make a difference.
Called the Sherbrooke Community Centre, it is located in Saskatoon. And the Alzheimer’s Society calls it a model program.
At Sherbrooke their philosophy of care is called the "Eden Alternative" and it seems promising. They claim "to counter the three plagues of loneliness, helplessness and boredom." But did they have the statistics to back up those words and what was the home like? We visited the Sherbrooke Community Centre in early September 2013.
Instead of living in hospital-like wards, residents live in "houses" or communal groupings living space. Sherbrooke calls them "villages". Groups of 9-10 residents live in each of these houses and there are homes for Veterans, Aboriginal residents, Ukrainian residents, and men with acquired brain injuries. In order to give residents flexibility over when and what they eat, there are kitchens and dining rooms within each of the houses.
More importantly, there are two staff for every 9-10 residents. Based on conversations with frontline care workers across the country, the number at Sherbrooke is about double what you would find in most nursing homes.
Suellen Beatty, the home’s executive director, explained how this different approach has led to fewer problems and happier residents.
"Using a resident directed approach, where people have opportunities for important relationships, have meaningful things to do in a day, and opportunities for growth has meant that people’s emotional needs are met in a way that results in the use of fewer psychotropic drugs, fewer altercations between people in the community, and overall a sense of increased well-being and joy for those who live and work here," she told W5’s Sandie Rinaldo while touring the facility.
"One of the reasons we can do that is because we’ve moved out of that institutional model where we run on such a tight schedule -- you know, the food cart isn’t leaving at a certain time so if you don’t get to the dining room on time, it doesn’t mean you missed breakfast. Our staff have the flexibility and they’re empowered enough to get breakfast for somebody any time of the day."
Sherbrooke limits the use of powerful anti-psychotics because they can cause confusion, loss of balance, and generally, a much lower quality of life for elders.
"Our use of anti-psychotics is at 8 per cent for people with dementia. In most homes in our health region, the use of anti-psychotics is at the over 30 per cent level," said Kim Schmidt, Sherbrooke’s leader of residential care services.
As for cost -- residents at Sherbrooke Community Care Centre pay an amount in line with other nursing homes in Saskatchewan, between $1,000 and $2,000 per month.
Watch Part 4 of W5’s Deadly Care to learn more about best ways to communicate and care for people with dementia. A quick tip from the professionals at Sherbrooke: Never correct people with dementia. It will just anger or frustrate them.
People first in dementia care
Alzheimer’s Society of Canada
An estimated 1.4 million Canadians will have dementia by 2031. As the incidence of the disease increases, the current gaps in the quality of dementia care in long-term care will multiply. And dementia costs are rising. Canadians will be spending $293 billion per year by 2040, up from the current $33 billion.
The Alzheimer Society of Canada and others, including long-term care staff, the medical and research community, people with dementia and family caregivers, agree -- we need a fundamental shift in how we deliver care that begins with the question: What can we do differently to give each person with dementia the best day possible?
Many long-term care homes are moving away from a medically focused, institutional model of care and are adopting more person-centred and relationship-centred care approaches. "Culture change" is an ongoing process and everyone plays an important role – residents, families and staff. In dementia care, there is no such thing as "one size fits all." People with dementia are just that -- people.
Our goal at the Alzheimer Society of Canada is to make person-centred care the norm, not the exception. Many long-term care homes share our vision. In 2008, the Alzheimer Society embarked on a culture change initiative. Last year, research was conducted in six long-term care homes across the country providing elements of person-centred care. One of the six homes we studied was Saskatoon's Sherbrooke Community Centre.
In these long-term care homes, families, staff and people with dementia are integral members of the team, each one bringing valued and unique expertise to bear. Partnerships among staff, people with dementia and their families lead to better outcomes and improve the quality of life and care for residents.
"Families can provide crucial support and give staff information about the needs, preferences, likes, dislikes and interests of the individual with dementia. When you know who they are as unique individuals, you are in a stronger position to reduce responsive behaviours because you understand the meaning behind their behaviour," says Mary Schulz, Director of Education, at the Alzheimer Society of Canada, who has been leading the charge towards person-centred care.
On November 2013, the Alzheimer Society of Canada will release the findings of its research. With the ever-increasing numbers of Canadians touched by dementia, it's time to change our mindset. It’s time to get to know the whole person, and look beyond their dementia.
